DPT Vaccine Adsorbed Vaccine (Combined) ( IAF 1990 )
(BioVac 1991 last year this vaccine was listed in the CPS)
Indications: Nearly all pre-school children are susceptible to diphtheria and whooping cough; the highest mortality to these 2 diseases is also found in this age-group. Tetanus, too, is a disease to which young children are often exposed as a result of minor wounds. It is therefore strongly recommended that the trivalent adsorbed D.P.T. vaccine be given to all children preferably at the age of 2 months or certainly within their first year. Thus, in one course of injections, protection is assured against the 3 diseases, diphtheria, whooping cough and tetanus. For children who have already had whooping cough and who are more than 6 years old, combined diphtheria and tetanus toxoids, adsorbed or non-adsorbed, is used to give protection against diphtheria and tetanus.
Contraindications: Vaccination of children who are febrile or who show other signs of acute illness or injection should be postponed. A simple cold is not a contraindication. Likewise, premature birth is not a reason for delaying vaccination.
Children known to suffer from neurological disease (uncontrolled epilepsy, infantile spasms, progressive encephalopathy) should not be vaccinated. Cerebral palsy or retarded growth, however, are not contraindications. Before vaccinating a child who has had convulsions, the possibility of any developing neurological disease must be excluded.
The use of immunosuppressive drugs can reduce the immune response. If such treatment is of short duration (about 2 weeks), it is better to wait for a month after the end of treatment, otherwise vaccination may be carried out during treatment. When a child returns for a further dose of vaccine, the parents should be asked if there were any reactions to the previous injection.
Vaccination should not be continued in children who have demonstrated: an allergic hypersensitivity; a temperature of 40.5ºC or greater during the 48 hours following vaccination; collapse or shock during the 48 hours following vaccination; persistent and uncontrollable crying for at least 3 hours after vaccination; an encephalopathy (changes in consciousness with local or general neurological signs) within 7 days of vaccination.
Children developing convulsions with or without fever within 7 days of vaccination should be examined medically and neurologically in order to ensure that there is not an underlying, evolving neurological condition before vaccination is continued.
It is recommended that children more than 6 years old should not be vaccinated with D.P.T. vaccine, adsorbed or non-adsorbed (fluid).
For children for whom the pertussis component of the D.P.T. vaccine is contraindicated, their vaccination program should be continued with D.T. vaccine, adsorbed or non-adsorbed.
Precautions: New sterile syringes and needles or a sterile disposable syringe and needles should be used for each patient to prevent transmission of hepatitis B virus or other virus from person to person.
Do not inject the vaccine intravenously or subcutaneously. To check that the vaccine is not being injected intravenously, withdraw the piston of the syringe before injection to ensure that blood is not being aspirated.
Adverse Effects: The injection of adsorbed D.P.T. vaccine can cause a slight elevation of temperature in children. The site of injection may become red, even inflamed, sensitive and indurated for 12 to 24 hours. Sometimes, the reaction is more severe. Bathing with cold water will lessen the local reactions. Systemic reactions, which can be severe and even fatal, have been reported occasionally.
Moderate systemic reactions (a temperature of 38°C or more, irritability, vomiting, anorexia, drowsiness) are fairly frequent and usually last for 24 to 48 hours. Severe reactions are much rarer and tend to occur about once in 310,000 doses.
It may happen on rare occasions following the first injection of the D.P.T. vaccine that a child gives the appearance of an allergy to the vaccine. This usually happens in children suffering from eczema, hay fever or asthma, or in children already sensitized to other antigens and who have previously been shown to be allergic. almost immediately after injection the child presents a reduced pulse, pallor, marked perspiration, vomiting, diarrhea and a general state of shock, all usually accompanied by areas of skin rash. Epinephrine must be given immediately.
If it is decided to discontinue the injection of adsorbed D.P.T. vaccine because of the presence of B. pertussis in the vaccine, the use of a vaccine containing only diphtheria and tetanus toxoids is recommended in order to immunize fully against these two diseases.
Note: It is desirable that every unusual reaction to vaccination, no matter what vaccine is being used, be reported to the manufacturer and to the provincial epidemiologist.
Dosage: To obtain lasting immunity in infants and pre-school children, I.M. injection of 4 doses of 0.5 ml of adsorbed D.P.T. vaccine is recommended. The first dose should be injected at 2 months of age and the first 3 doses should be given with 1 to 2 months between each dose. A fourth dose is necessary for maximum, long lasting immunity: it should be given 9 to 12 months after the third dose.
The use of half or fractional doses is not recommended because it may reduce the efficacy of the vaccine without necessarily reducing the incidence of severe reactions.
Booster doses: The i.m. injection of a further dose of 0.5 ml of adsorbed D.P.T. vaccine is strongly recommended in a child's fifth year or before school entry. This booster dose reinforces the existing immunity.
Withdrawal from an ampul: Shake the ampul well to disperse the contents before withdrawing the vaccine. Tap the ampul gently to make sure that all the vaccine is in the lower, main part, and that none is in the narrow neck. Using a sterile cotton wool swab or serviette, break the neck of the ampul where indicated by the colored line (no file is required). Taking all necessary precautions to avoid contamination, and with a sterile needle attached to a sterile syringe, withdraw the contents of the ampul into the syringe, holding the ampul so that the point of the needle is always immersed in the vaccine throughout the time of withdrawal.
The contents of an ampul should be used immediately; unused vaccine should be discarded.
Withdrawal from a vial: Never remove the rubber stopper from the vial. Shake the vial well to disperse the contents before withdrawing the vaccine. Bend over the central portion of the metal cover. Moisten the exposed rubber surface of the stopper with a plug of sterile cotton wool previously soaked in a suitable antiseptic and allow the antiseptic to act for a few moments. Draw into the sterile syringe a volume of air equal to the amount of vaccine to be withdrawn from the vial, then insert the sterile needle and syringe into the vial through the centre of the rubber stopper. Invert the vial and slowly inject the air from the syringe. Keeping the point of the needle immersed in the vaccine, withdraw immediately the required amount. Finally, withdraw the syringe and needle from the vial, making sure that the piston of the syringe is prevented from moving. It is desirable that the entire contents of a multidose container be used at the same vaccination clinic. Only a proven aseptic technique allows the sampling of vaccine doses from an unfinished multidose vial from a previous vaccination clinic.
The skin at the injection site should be cleaned with a suitable antiseptic and wipe clear with sterile dry cotton-wool. Inject the vaccine i.m.: in infants the anterior-lateral aspect of the thigh (the vastus lateralis muscle) is a convenient and safe site. A syringe of 3 ml capacity filled with a 25 calibre needle 1.5 cm long is best suited for injection. For older children, the best i.m. site is the upper arm (the deltoid muscle).
Disposal: Adsorbed D.P.T. vaccine and other materials used during the vaccination session can be disposed of in the same way as all other medications. Since adsorbed D.P.T. vaccine is an inactivated vaccine, there is no risk of infection as a result of handling.
Supplied: The combined, adsorbed D.P.T. vaccine is a sterile, opaque suspension of diphtheria toxoid, pertussis vaccine and tetanus toxoid adsorbed on aluminum phosphate and suspended in isotonic saline. Each 0.5 ml of vaccine contains one dose of: purified diphtheria toxoid 25 Lf units; pertussis vaccine 4 to 12 protective units (PU) purified tetanus toxoid 5 Lf units, aluminum phosphate 1.5 mg and thimerosal 0.01% as a preservative. Prescored single dose ampuls of 1 ml, multidose vials of 10 ml. Boxes of 5. Store in refrigerator between 2 to 8°C. Do not freeze. Carefully check the expiry date. Outdated vaccine should never be used.
Reviewed 1988
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